World Mental Health Day

The theme of World Mental Health Day 2016 is helping people in distress. I’ve been asked to speak at an event organised by Mental Health First Aid. This blog is a precis of my talk.

My brother lives in the US. With a foreign passport and a surname like Rodrigues, he – and we – are watching the American presidential election with vested interest.

Many times we have heard Donald Trump express views we know to be racist or sexist. But recently, he took aim at a new target: those with mental illness. He opined that soldiers who experience post-traumatic stress disorder are in some way weak. As though being strong equates to having no feelings. Given recent revelations about other things Trump has said, there wasn’t a lot of fuss about this. Vice President Joe Biden said that the comment just showed how out of touch Trump is.

But actually he isn’t. Donald Trump is popular in certain quarters because he says what he knows many people are thinking. And in doing so, he speaks not only for some Americans, but for people in other parts of the world. Including the UK.

I want to tell you why Trump, and others who think like that, are wrong. And not just because thinking that way is unkind. It is also wrong intellectually and on economic terms too.

Mental illness is in some ways like physical illness. If you know what you are looking for, you may be able to see it through a microscope or on a scan. And you can use chemicals to treat the symptoms, although not the causes.

And as with physical illnesses, the causes are multi-factorial. Just like cancer, which doesn’t happen to “weak” people, mental illnesses are triggered by genetic, environmental, social and behavioural factors.

But unlike with most physical illnesses, people make judgements about you if you are mentally ill. Nor do they think the sort of thing Donald Trump said. That people like me, and many of you, who experience mental illness from time to time, are weak.

In fact we are far from weak. Because another thing that differentiates mental illness from physical illness is that as well as having to cope with that sort of stigma plus the challenge of having an illness that messes with your head, people like us also have to learn to reframe our thinking and our behaviour if we want to achieve recovery.

It is important to understand the links between psychological trauma and mental illness so that it can be prevented as well as treated. And to realise that, with enough trauma, almost all of us will exhibit symptoms of mental illness.

Let me tell you about two people.

I met Ally a couple of years ago when she and I were invited to speak to new NHS managers. Since then we have shared a lot. She said it would be OK to write about her here. Ally’s Post Traumatic Stress Disorder (PTSD) was triggered through a toxic working environment, plus some specific events that occurred in Chernobyl where she was working, including the death of two colleagues, which were then covered up. She says that prior to this, she was a workaholic who self-medicated with alcohol. After these terrible events, she tried to raise her concerns but was ignored and bullied. She got ill, and eventually lost her job, became homeless and nearly died through self-neglect. But although some sat in judgement of her, there were people who took time to listen to her and to recognise that such terrible things would cause damage to any of us. They helped her to take recognise this and to take her first slow steps towards acceptance and recovery. Some were professionals but some were ordinary people.

Then there is Odi. Odi and I came across one another in 2005 over some changes to local mental health services. He wasn’t well, and I struggled to understand what he was trying to tell me. But there was something about him that was unforgettable. We met again, and gradually I learned that he had experienced terrible trauma including torture in troubled parts of Africa. This led to him hearing voices. He didn’t want to take conventional medicine. He wanted to heal himself through traditional non-invasive methods.

He was allocated a social worker who appreciated that to achieve recovery, Odi needed honesty, understanding and acceptance. Over time, and supported by that social worker, Odi used art and music to help himself and then others, eventually taking a degree in art therapy. He then decided to become a social worker himself. This year Odi completed his Masters in Social Work. He was awarded Student of the Year on his course at the University of Sussex, and has been shortlisted as national Social Work Student of the Year. I would be very surprised if he doesn’t win. He is wise and good and has the heart of a lion. Anyone who gets Odi as their social worker will be blessed. Like Ally, it is an honour that he has become my dear friend. The photo is us doing selfies at Brighton and Hove Albion.

And then there is me. I’ve written before about how I got to where I am now, and that I am still a work-in-progress. But for those who don’t know, I saw my first psychiatrist aged 15. He was kind. But he couldn’t help me with my feelings of self-hatred and despair because I convinced him that I was OK. The next few years were pretty grim. I got through my nursing training by perfecting the art of seeming ok when I wasn’t. And when I ended up in hospital after an overdose and the nurse told me I was a waste of space and selfish because I was taking him away from people who were really ill, I believed him. In fact, I agreed. I had huge compassion for others but none at all for myself.

I have muddled through my life, and achieved some successes. But it was the attention and kindness of others, including Sue Baker at Time to Change, that eventually led me to realise that opening up about my experiences of anxiety and depression would be a generous act. Rather than a sign of my own weakness. I did so, at considerable personal cost, the year before I retired from the NHS. Nowadays, I know being open is not only kind to others. It is also a kindness to myself.

In being more open, I have made some amazing friends and learned so much. And the greatest thing is that people like me, and Ally and Odi, and some of you, are not flawed or weak. We have simply had to face things others have not. And in facing them, we have developed skills, understanding, humility and compassion that make us better humans than we would have been had we not had to do this.

This is why Donald Trump, who is wrong in so many other ways, is wrong about soldiers who experience PTSD. Those men and women who have served their country and found the experience traumatic are far from weak. They are human beings and also heroes. And they deserve gratitude, sympathy and support.

Thank you reading this. Thank you for helping others, for taking time to ask someone how they are. And thank you for really listening to what that person says. It is a wonderful, compassionate and extremely effective thing to do. You are helping to save and change lives.

Like the Booker Prize, World Mental Health Day seems to come round faster each year. Both are a time for celebration. In the case of World Mental Health Day, it is also intended to raise awareness on the importance of wellbeing, of not stigmatising people who experience mental illness, and of the links between how people are treated – at home, at work and in their communities – and the mental health of the population, which impacts on everything, including the economy.

I will write about literature and mental health another time. Of interest to me this year is another juxtaposition with World Mental Health Day. I’m talking about the belated announcement on the state of NHS finances for the first three months of 2015/16, and what Professor Keiran Walshe has described as the triple whammy:

Lack of adequate growth funding to match the inexorably increasing demand of an ageing population and the many new treatments which patients have grown to expect

Much higher expectations on standards and staffing from regulators and the public after crises such as Mid Staffordshire

Pressures on the NHS caused by increasing problems in funding and delivering social care

There have been a number of wise comments on what this means, none better than by Professor Chris Ham of the Kings Fund. Here at 07.10 on the Today programme, he explains that the Treasury has no option but to foot the bill in the NHS and social care, OR the government must come clean with the public about the unpalatable choices that the NHS will have to make in order to balance the books.

This has never happened before in my memory. And I am worried for my former colleagues. There are now so many trusts in “special measures” that the measures can no longer be considered special. The organisations whose role was to support troubled trusts, the Strategic Health Authorities, were reorganised out of existence under the reforms that some seem to have forgotten preceded the current crisis. There seems little possibility of NHS Improvement, the new body about to be formed from the independent regulator Monitor and the Trust Development Authority, being ready or able to act with the speed, depth and impact required to stop the multiple trains about to hit the buffers.

There have already been a few high profile dismissals/resignations. And there are increasing concerns about the demands placed on those prepared to run trusts these days. Knowing that everyone else is in a similar position is not much help when you are lying awake in the small hours wondering how you will meet all the bills and not run out of cash while juggling all the other demands that keep patients safe. Doing this while wondering whether you will have a job yourself by the end of the month does not help.

Rosebeth Moss Kanter wrote about the difficult “middles of change” in the Harvard Business review in 2009. She said:

Welcome to the miserable middles of change. This is the time when Kanter’s Law kicks in. Everything looks like a failure in the middle. Everyone loves inspiring beginnings and happy endings; it is just the middles that involve hard work.

It’s worth reading the whole article and reflecting on why it is that we ignore such wisdom in the NHS.

The NHS is at the start of the most difficult middle it will ever face. At such a time, it seems vital to me that NHS trust leaders, staff, commissioners, regulators and partners do a small number of things, and take great care to avoid some others.

Remember why you are there. Hold hard and true to those values

Get in the same boat with everyone else and start rowing together in the same direction

Give praise and encouragement frequently and generously. Remember that humans need on average a ratio of 12:1 praise to criticism. People give discretionary effort when they are heartened. When they are disheartened, they lose hope and eventually give up

In particular, avoid criticism which plays to the gallery, scores points, justifies your own position or for which there is not a readily applicable solution

When making difficult decisions for which there are no easy answers, ask what you would prefer to be pilloried on the front page of the Daily Mail for. Then do that

In a crisis, kindness is much underrated. Take care of yourself and be kind to yourself. Only then can you be truly kind to others

Happy World Mental Health Day 2015 everyone. I send you much love. Thank you for doing what you do. You are amazing.